Note: The authors intend to expand this section significantly
in the future including a CME quiz. The cases below represent a sampling
of the included material.

Case 1
A 38-year-old man comes to the emergency department after falling 15 feet off scaffolding at work. His systolic BP is 90; his heart rate is 125 bpm. He is on a backboard and in a C-spine collar and complains of severe pain in his back and abdomen.
You perform the FAST ultrasound scan as part of your trauma evaluation and find the following:

ED management:
Immediate transfer to the operating room for exploratory laparotomy. The patient is clinically unstable and has a presumed intra-abdominal bleed, most likely from a solid organ injury or vascular injury.

Case 2
A 57-year-old male comes to your emergency department complaining of vision
loss in his right eye. He says he has seen “floating
dark spots” for a few days. After seeing a “flash of light”,
he can’t really see much with his right eye.
Upon physical examination the patient is able to distinguish between light
and dark but unable to count fingers with his affected eye. His visual
field is also significantly diminished. You perform a bedside ultrasound
and find the following:

ED management:
This patient presents with an acute onset rhegmatogenous detachment that involves or threatens the macula. An immediate retinal specialist consultation is indicated for surgical repair.

Case 3
You walk through the ED and notice a patient leaning over a chair in his
exam room. He
is a 55-year-old male waiting to be seen. He informs
you he came to the hospital because of shortness of breath, chest pain and
dizziness. He tells you this started a few weeks ago. In
the beginning, sitting up alleviated his symptoms. Now he really has
to lean over a chair or lie on his stomach to get any relief. The
patient denies any trauma. He is a smoker but otherwise in good health. He
came in today because he feels like he is going to pass out. His triage blood
pressure is 90/60 mmHg. You perform a bedside ultrasound with the following
result:

ED management:
This finding requires immediate intervention. The pericardial effusion most likely developed over a few weeks but is now causing tamponade. Emergent drainage is indicated in the emergency department before admission to the hospital.

Case 4
A 42-year-old female patient complains of sudden severe right flank pain. During
your interview she is restless and seems unable
to find a position of comfort. On exam she is afebrile, her vital signs
are stable and she has tenderness over her right flank. You perform
a bedside ultrasound and find the following:

Image case 4
Your diagnosis:
Mild hydronephrosis right.

ED management:
On extended bedside ultrasound her left kidney appears normal, also her aorta and FAST exam show no abnormalities.
Symptomatic treatment with IV fluids and pain control resolve all symptoms. Patient will need urgent outpatient follow-up with urology for renal colic with hydronephrosis without signs of infection and normal renal function.

Case 5
88-year-old man comes to emergency department for worsening abdominal pain over the last 1 week. He used to smoke and has hypertension. His vital signs are stable. Your bedside ultrasound shows this finding:

Case 6
A 23-year-old woman presents to the ED with nausea and vomiting for the past
few days. Her last period was regular but very light and she can’t
remember the exact date. She does not take birth control or fertility
drugs. Her abdominal exam is unremarkable, on pelvic exam the cervical
os is closed. You perform a bedside pelvic ultrasound:

ED management:
Nausea and vomiting resolve with IV hydration and medication. The patient is discharged with outpatient follow-up with OB and started on pre-natal vitamins.

Case 7
A 35-year-old female arrives in your ED with significant abdominal pain. She
had a positive pregnancy test about 3 weeks ago and denies vaginal bleeding
or trauma. She tells you she took Clomid before getting pregnant.
On exam her abdomen appears very tender. You perform a transabdominal
ultrasound and discover an intrauterine pregnancy. You continue
your exam with a pelvic ultrasound study because her pain and tenderness
are disproportionate. Your exam and find the following:

ED management: Heterotopic pregnancy, once thought to be an extremely rare phenomenon, is becoming more common. Risk factors include pelvic inflammatory disease and fertility treatments. This patient has an ectopic pregnancy and an acute abdomen. Emergent OB evaluation is indicated with surgical removal of the ectopic gestation by salpingectomy or salpingostomy.

Case 8
A 45-year-old patient presents with upper abdominal pain. Her symptoms
began after eating a burger. On
exam she is tender over the right upper abdomen. She mentions that she had
two similar episodes recently, but they were less painful. You
start symptomatic treatment, order blood work and perform a bedside ultrasound:

ED management:
Blood work shows no infection or elevation of liver or pancreatic enzymes. The
patient improves with symptomatic management and her pain resolves. She
is discharged from the ED after surgical consultation and planned outpatient
follow-up.

Case 9
A 23-year-old man comes to the ED after being assaulted. He describes being kicked in the groin and has significant pain. On exam he is tender over his right testicular area with scrotal swelling and ecchymosis. Your bedside ultrasound shows the following:

ED management:
Emergent urology consultation. Early surgical exploration of a fractured testicle is associated with higher rates of testicular salvage.

Case 10
A 33-year-old man was robbed at a gas station and punched in the face. He
is brought to the ED for evaluation and says he thinks he heard a gun shot
and felt a sharp pain in his neck. On exam his neck has a small abrasion
and is tender. You
perform a bedside ultrasound and find the following:

ED management:
The foreign body is removed without problems. The remainder of the trauma evaluation is negative and after an observation period the patient is discharged home. Tetanus is updated before discharge.